2177 Q � I yV IYCiC.Crf'�-�/ K LOT NO
�—11 NO. TREET
N FOR ,PLUMBING PERMIT
4 �Y OF CUPERTINO
zi
" o l UN 18196 Sanitary No.
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3 A Date I Of,�' Permit No ,Z7
a 6atiofis
r��p�Rnfi�'F6 'Ftt3�I�[ Pee $o
r y e to he City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all her laws applicable t �teto.
~ F Use of Premises
00 111
3 Owner _ Address 61 -b �O� / ' E.',i�
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a 4 B e Address ZU J7 �Ax .0 1AiCZrfe
3 r O NTRACIOR, XGEi4T_
— W Phone — 2 7 �S
ao State Licens - Approved
'S
PLUMBING INSPECTOR
FIXTURES M ER MAIN R I
UNITS FEES UNITS FEES
Water Hcatnr Size
Water Closets Matcria':
Bath Tubs To Curb
Showers To Prop. Line
Lavaturics To Existing
Kitcheri'Sinks Not Conn.
:Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
"seater Softeners Material
Bar Sinks To Main Drain
Comb. Sink c Trays To Curb
Dental Uniis
Drinking Fountains
Floor Drains WATER SYSTEM '
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ,p U
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee
Permit Fee , 00
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
-Iain Drain
Final...